Surgicalists: The Cutting Edge

Orthopedics

Acute Orthopedic Surgery Programs Treat the “Ouch!” of Emergency Surgery Needs

Too often, patients with broken bones or other injuries that require the services of an orthopedic surgeon arrive at the ED only to discover these specialists aren’t available. The patient must wait for treatment, or sometimes be transferred to a facility out of their local area. The result is delayed treatment, inconvenience for both patients and families, a greater risk of complications and potentially a loss of revenue for the hospital when patients are transferred.

As a result of these challenges, orthopedic surgeons who function as acute orthopedic surgeons or orthopedic hospitalists are one of the latest trends in hospital medicine. Many surgeons find that being part of a comprehensive program that provides round-the-clock coverage and care for patients is preferable to the demands of a private practice and/or the inconvenience of taking call at the hospital. Being part of a highly qualified team of surgeons and advanced practitioners, who are embedded in the hospital 24/7 to ensure continuity of care, means that surgeons can enjoy a manageable work schedule, a professionally exciting career and competitive compensation.

For hospitals, the benefits are also compelling: the continuity and standardization that improves patient care and reduces complications, plus a team of highly qualified surgeons who are aligned with their goals to reduce unnecessary readmissions, achieve high patient satisfaction and reduce medical errors.

Pamela Mehta, MD, Surgical Affiliates Chief of Orthopedic Surgery, believes that, “The goal for every patient should be access to high quality surgical services no matter what time of day or night it’s needed. Applying acute care surgery standards to the orthopedic model can improve performance and resolve ongoing issues of reducing complications, improving outcomes, lowering costs, increasing efficiency and enhancing patient satisfaction.”

The acute orthopedic surgery program is a long-term, sustainable approach to meeting orthopedic surgery needs in a community and ensuring consistent coverage for patients needing both emergency and general orthopedic surgery. The program can be implemented as both a stand-alone and as a complement to acute care surgery and trauma programs.

What’s behind the growth of the acute orthopedic surgeon?

In short, it’s the same forces that are fueling the growth of the acute care surgery or surgicalist specialty in general:

  • Increasing reluctance of surgeons to be on-call for emergency surgeries
  • The growing shortage of ED physicians and surgeons (including orthopedic surgeons)
  • Increasing ED patient loads and an uptick in ED cases among the newly insured
  • The failure of the old model of on-call surgeons and specialists to keep up with the demand of higher quality and efficiency metrics; instead the old system can result in delays in patients getting the treatment they need, difficulties in providing standardized care, and lead to complications as well as a lack of efficiency in hospital operations

What factors go into a successful program?

An acute care surgery program, including those with acute orthopedic surgeons, must be much more than having surgeons based in the hospital. The acute orthopedic surgery program must be built upon leadership from expert surgeons and executives, outstanding surgical teams that follow evidence-based guidelines in care delivery and collaboration with the hospital staff to consistently improve patient care and safety.

When this model is in place, patients, hospitals and local orthopedic surgeons can reap the benefits of:

  • Better access for patients to this specialized care. Orthopedic surgeons are available any time of the day or night 24/7
  • Lower average length of stay for patients and as a result, lower treatment costs
  • Community orthopedic surgeons freed up from taking ED surgical calls or in-hospital consults, enabling them to increase the efficiency and volume of their private practice and elective surgery case loads
  • Orthopedic surgeons have an attractive alternative to the long hours and demands of a private practice
  • Increased market share and revenue for hospitals
  • Meeting the requirement for hospitals seeking higher level designation trauma centers, including Level I and Level II, to have trauma surgeons available that are trained in orthopedic surgery

Orthopedic surgeons who are interested in learning more, click here: http://www.samgi.com/orthopaedic-surgery/. Hospitals interested in acute orthopedic surgery programs, click here: http://www.samgi.com/for-hospitals/.

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Case Studies, Quality of Care, Surgical Hospitalist Results

Expanding Surgical Care at Rural Hospitals

In the event of a traumatic medical emergency, millions of Americans—especially in rural areas, home for more than 14% of Americans –don’t have access to a qualified surgeon. When an accident does occur, they have to travel miles and hours to find the care they need, putting their health at risk. Often ambulances will pass right by a community hospital to get patients to a qualified trauma care facility. It’s a loss for patients, families, hospitals and the community.

Why is there such a shortage of surgeons in rural America? There are many reasons. The American College of Surgeons notes that more than half of surgeons practicing in rural areas are nearing retirement. In addition, substantial numbers of new general surgeons choose to specialize, and because of the small number of patients in rural areas, there is not enough demand to support these specialty practices. Surgeons often choose to work in or near urban areas, where there are a wealth of professional opportunities for them and amenities, schools and resources for their families. Medical students who might consider rural surgery attend university-based surgical residencies in urban environments. Without exposure to and mentorship from rural practitioners, they often choose to stay in urban facilities.

This situation creates many challenges for hospitals and communities. Frequently elective surgeries are scheduled out of the area, while community residents often choose to simply travel to other locales for health care. Even in emergencies, patients are often diverted 50 miles or more to other facilities.

Sutter Amador Hospital, like many others in rural areas, faced the challenges of 1) recruiting top-notch surgeons, 2) serving and retaining patients in its demographic and 3) achieving long-term clinical and efficiency outcomes.

While providing a range of much needed and high-quality health care services to its patients, the hospital sought to find a way to give its patients and community access to high quality, 24/7/365 acute care surgery services. To that end, hospital leaders began an intensive effort to address their need for qualified surgeons.

They had a strong and successful model to follow. In 2007, their affiliate hospital in the Sutter system, Sutter Medical Center, Sacramento (SMCS) launched a surgicalist program with Surgical Affiliates. A five-year study of the program published in the Journal of American College of Surgeons showed it had generated significant improvements, including:

  • Length of stay for general surgery cases decreased by as much as 12% – from 6.5 days to 5.7 days.
  • Complications were reduced 43% – from 21% to 12%.
  • Readmissions decreased slightly. However, the key fact is that while length of stay decreased significantly, the readmission rate did not increase.
  • Hospital costs decreased 31%, from $12,009 to $8,306, indicating potential savings of $2 million or more in a single year for a facility of this type and size.

With this example of how the surgicalist program, also referred to as a surgical hospitalist program, had transformed hospital performance and addressed the surgeon shortage, Sutter Amador and Surgical Affiliates made a commitment to replicate this success with 24/7 surgical teams and a collaborative and programmatic approach that would consistently improve both patient outcomes and hospital efficiency metrics.

Three years into the program, Sutter Amador is already seeing significant outcome improvements and results.

  • Inpatient, outpatient and total cases increased 250%
  • Volumes of laparoscopic procedures doubled and tripled
  • Average length of stay (ALOS) decreased
  • Hospital Case Mix Index (CMI) increased .0853%

The increase in volumes and improved metrics generated a positive ROI for the program. Additional benefits include the ability to ensure 24/7/365 call coverage; a cap on skyrocketing payments to surgeons and locum tenens companies, thus ensuring greater predictability of expenses; and improvements in the overall responsiveness and timeliness of care. All that and patient satisfaction increased as well.

The success Sutter Amador Hospital has achieved is an outstanding example of how to bring quality surgical care to rural areas. It proves that the surgicalist model works in a rural hospital environment by delivering acute care surgery based on evidence-based guidelines. The result of the model is improved quality of care, patient safety and hospital performance.

If you’re interested in learning more, please request our case study entitled “Off the Beaten Track: A Road Map for Expanding Surgical Care at Rural Hospitals” at http://www.samgi.com/news-type/case-studies/.

i Rural Health Info: https://www.ruralhealthinfo.org/states/united-states
ii New England Journal of Medicine, “Physician Shortages in the Specialties Taking a Toll, March 2011 ( http://www.nejmcareercenter.org/article/physician-shortages-in-the-specialties-taking-a-toll/)
iii The Journal of American College of Surgeons, “Sustainability and Success of the Acute Care Surgery Model in the Nontrauma Setting,” July 2014, Volume 219, Issue 1, Pages 90–98

Acute Care Surgery, Quality of Care, Surgical Hospitalist Results

Acute Care Surgical Programs: Expanding Surgical Care

As hospitals continue to deal with pay-for-performance, accountable care and population health management, it’s vitally important for them to consider how emergency surgery services are delivered and how it impacts their success.

One new resource on this topic is an article I recently wrote for the inaugural issue of Management in Healthcare, a new peer-reviewed journal. The article examines how, by implementing the service model developed for trauma and applied to emergency surgeries, it is possible for hospital’s most at-risk patient groups to receive standardized care according to best practices and practice management guidelines 24/7.

The result: high-quality care and better performance outcomes for the hospital. Plus, continuous quality improvement initiatives that touch multiple hospital departments, raising the bar on performance throughout the facility.

This new model for acute care surgery, also referred to as surgicalist programs, can help hospitals achieve results, as well as enhance their competitive position. Metrics show that a well-structured surgical hospitalist program can improve patient outcomes and improve costs. For example, a July 2014 paper in the Journal of the American College of Surgeons highlighted how a surgical hospitalist program produced sustainable results, including a 31% reduction in hospital costs and complications declined by 43%.

Read the article here.